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Hello, well, the last blood test showed it was time to start and even i was past my own deadline...

I went 5 years before needing to go on meds.

I am a male in his late 40's for reference.

My attitude is optimistic. This last Winter and Spring, I really haven't felt that well. I've not had an OI, but fatigue and lingering colds were a first and persistent.

With that as a backdrop, the situations is now about trading the side effects of the meds for the side effects of the HIV, which while not debilitating yet, was getting to me.

I started the combo Friday, May 22.

As directed, I am taking this combo in the morning after a small breakfast which was an English Muffin with Peanut Butter and Jelly, a Cup of coffee and an Activa Yogurt. (The drinkable kind). I looked at my blue pills, 1 Truvada and 2 Reyataz, popped them in my mouth and down the hatch.

In preparation of the expected digestive upset. I'm ready to take 10 grams of glutamine in a pysillium fiber drink. (costco) And i have freeze dried ginger tablets for nausea and some grass if I need it.

Of course I did all sorts of things trying to stay of meds for as long as i could. Supplements being utilized to delay this day. I can honestly say, I have no idea if they did or did not delay the need for meds, but my doctor thought they might have had some effect. He really didn't think I was going to last this long.

So, it would seem its that right of passage, at least in my mind, as I now cross over into the next stage of my HIV progression. The use of medication to lower my Viral Load, and hopefully helping my immune system recover.

I would say my mood at that point I took the pills was, enthusiastic. Which surprised me. After spending considerable time and effort to stay off of meds for as long as reasonable, I didn't hesitate to get the prescription filled immediately and begin immediately the next morning. (My doctors appointment was thur.)

I very well know that this forum documents very well the bad and difficult reactions to meds.

My understanding simply is that those that are fine, aren't writing in for what ever reason.

I made a promise to myself that i would document my progress good, bad or in between on this forum.

Results of the first day were: (Docs advice was to start this weekend if I wasn't really doing much. the three day weekend being a quiet time I can stay near home and presumably the toilet, and of course then deal with the other possible side effects.)

Some slight digestive discomfort. I did in the afternoon take a 10gram dose of glutamine in fiber drink.

I did have a couple of moments on the toilet, but nothing too unsettling.

My honest feeling were rather celebratory! i know what was going to happen without the meds. My CD4 at the last test was just below 300 and dropped significantly from my feb test. Although I felt that the number was a bit "artificially low" do to physical factors from the past weekend prior to the test, none the less, not what i was expecting. My feeling is that I'm now going to put HIV in its place, and I'm going to try to get back to feeling better than I have been.

No problems during the night. I got a pretty good nights sleep. Did not get up once, and no digestive disturbance or problems at night.

When I woke up... Still feeling pretty good about it. And repeated the routine. I'm going to go out today... But I'm going to take the glutamine and fiber drink first and pop a ginger tab.

well in fact, the guideline are written for reyataz are Either boosted or NON boosted which is my current choice.

400 mg of Unboosted Reyataz or 300 mg with Norvir.

I choose to pursue the unboosted regimen, based upon latest research indicating that unboosted PI can be just as effective if adherence is high, because I have liver issues, and cutting one drug out may make transition that much easier.

Doctor would prefer if I went boosted as he views this a preferable as he would like to see research that measures performance of unboosted vs. boosted reyataz.

But since the guideline is written either way... He didn't give me a real hard time about it. We will monitor results of course monthly over the next three months. I may integrate norvir in later, if it seems like an improvement.

Because I'm choosing this path, doesn't mean its the right one. We shall see. So far Rounding through day two. I can feel it in my belly, but its not bothering me.

Hello risred. I'm currently taking Reyataz as well. Just to say I'm fairly sure I read somewhere that psyllium preparations shouldn't be used too close to your meds (two-four hours either way) as it can bind to your meds, preventing absorption.

Also, current guidlines state that if Tenofovir (Viread) and Reyataz are used together, then the Reyataz MUST be boosted with Norvir. This is because Tenofovir antagonises Reyataz, leading to suboptimal levels in the blood. Tenofovir is one of the drugs in Truvada. I urge you to check this with your doctor as soon as possible.

But since the guideline is written either way... He didn't give me a real hard time about it. We will monitor results of course monthly over the next three months. I may integrate norvir in later, if it seems like an improvement.

I echo what BM said above and also, Dr. Joel Gallant has said: "I can't think of any circumstances in which it would be OK to take Truvada and Reyataz without Norvir."

Morning was the same routine... light breakfast, and took my pills with activa yogurt drink.

Again, maybe an hour after, a slight bulky feel in my gut. Buy the afternoon, felt fine. Eating basically anything I want. I fell that I can go anywhere with little concern.

.......

Lessons learned... Rushing making decisions is not a good thing...

My appointment with my doctor was a mistake. i came in on the date i was given, however clerical mistakes occured and they worked me in. My normal appointment felt rushed as I had this feeling that I uprouted the schedule and my doctor just wasn't ready for me.

My bloodwork was also a bit behind schedule, but they did get my CD4 count and that when we both decided now is the time.

I had been preparing for this day for 2 years now, but I haven't been thinking about regimen as we had discussed previously. Originally, I was thinking Epzicom and Reyataz which would be ok unboosted. But somewhere along the line i got my opinion crossed... And started thinking Truvada / Reyataz.... Mostly my doctor goes with Atripla as first line as in his University hospital practice, adherence is the number one issue. So i was already off script. But that was ok.

All along my Doctor was a proponent of boosting reyataz. But what was lost in the conversation is that one "had" to boost with certain combinations, as opposed to preferred but optional.

I think my determination to go unboosted caught my doctor off guard.... Epzicom/Reyataz is the combo that can go unboosted. But with the recent less favorable press on Epzicom vs. Truvada, at some point I began favoring Truvada in my mind. I should have realized that I had to go boosted with Reyataz/Truvada.

Thanks for pointing this out. And it just shows, rushing without reading, thinking that you know, doesn't mean your not making a mistake. Double Checking is really the important thing.

So I'm continuing to take this combo but will be calling my doctor for his opinion and what i should do. Frankly. i know have 90 days of Reyataz 400 mg. and Truvada supply. I am inclinded to switch to Epzicom to stay unboosted Reyataz. But I'll find out why my doc was willing to go this way initially, with the though of moving me to boosted in a couple of months.

Part of my consideration and conversation with my doctor was that i seem to be very sensitive to drugs. As an example, I told him how i took just one Muscle Relaxant recently, and how it wiped me out for 3 full days. This on a prescription that stated 3 per day every day. This is pretty typical for me, and I've always been concerned that the "standard" dose may simply be way to much for me. But there are no tests for determine level of medication in ones blood.

I don't know if this revalation influenced him, and in both our hurry, he said OK to my request to go unboosted Reyataz with the Truvada.

This is day three and my third dose. I hardly noticed anything much 1st and 2nd dose. 3rd does and its even easier. So far no rash, no fever, no headache, no serious stomach upset or diarrhea. I just wish i had reviewed the material before pushing for this combo....

But thanks to you guys, you made me look. I appreciate it no end! Thank you!

The idea that our thoughts and emotions can be cognitively adjusted is a part of dealing with the fear of side effects of the meds, in my opinion.

We all have fears, but for me, when i look at my pills, this is what I think....

This is how I'm going to live longer, only with these pills.

I lead an active life and don't want to give in to HIV. While HIV certainly dominated my thoughts for maybe 2 years after diagnosis, i would say that HIV is just a part of me. And right now HIV is winning its battle for my body.

In order for me to keep HIV to the sidelines, as best that i can choose to do, I will dutifully take my pills with the mindset.

Only with these pills can I live a longer, better functioning life.

I'll deal with the things that come, if they come. For all we know, the famous side effects may pass me by, but the HIV will definitely take me down if I don't suppress it.

For me, its better to accept the ability to control the HIV than to worry of what may or will come next.

Frankly. i know have 90 days of Reyataz 400 mg. and Truvada supply. I am inclinded to switch to Epzicom to stay unboosted Reyataz.

hi.

in my other tread about changing my meds because of the hassle of picking up the Norvir, my Dr. initially approved the change to 200mg bid of Reyataz and the Truvada. I got the initial prescription in the mail but before I had even started it, my Dr realized her mistake and we went back to the 300mg Truvada boosted by the Norvir. Not wanting to waste the 60 days worth of the 200mg Reyataz, my Dr told me to go ahead and take 2 of the 200mg Reyataz at the same time and boost it with the Norvir. When I'm finished with that, I'll drop back down to the 300 mg.

make sense?

So I'm thinking. when you see your Dr just ask him about adding the Norvir now. As the others have said, this is a good combination. I've been on it for 5 years and have no complaints.

Isn't the heart problem with the abacavir component of Epzicom overstated? That is, even though (some) studies have shown that it can double your risk of a heart attack, if your risk for heart problems is low anyway, not much is going to change. E.g. a 1-in-50,000 risk isn't much different from a 1-in-25,000 risk.

1) In head to head tests, there seemed to be an indication that Truvada is more effective with a high VL than Epzicom.2) Truvada components are favored as part of Atripla.3) Generally superior tolerability of Truvada.4) Apparent durability of Truvada.

....

As to increased vascular risks of PI based regimens, Reyataz seems the most benign, but there are some markers point to issues with Reyataz.... But as my doc says and you pointed out. All these studies that point to elevated risk, are often marginal risk increases. One has to compare that slight elevation of risk to the risk of OI with HIV, which is more of a certainty.

It just seems like Truvada has the Edge of Epzicom. Not that Epzicom is "bad" or "inferior" as a drug.

------

The other aspect of my thinking is "why" take norvir if there is another way.

I have periods where I'm out camping and travel for several days at a time. Keeping Norvir Refrigerated is a pain.

Norvir manipulates uptake in the liver of the PI. I have concerns because I have a fatty liver, and already have elevated enzymes before treatment started. HIV meds in general will have impact on the Liver and Kidneys. Truvada has potential issues, Reyataz has its issues... So I'm trying to keep it as narrow as I can.

But I'm not Against Norvir. I'm just trying to work around it if I can. If my doc considers this just a transitional period to a boosted regimen, which is what i think he was advising me in our too brief discussion, And everything looks good, then adding Norvir may be the choice to make vs. Change to Epzicom...

urgh!

-------

And to Mark, as front line treatment, my Doc isn't "favoring" combivir. What we have been talking about for two years has been either PI based with Reyataz, or Atripla as best initial options. I choose PI based because I'm preferring a morning option vs a before bed option, which seems favored for Atripla in general. Although there are those who can take Aripla in the morning.

And to Mark, hey, don't sweat missing the Norvir, you do more for more people as a LTS! I do feel like an idiot... But its a valuable lesson. So I swallow my pride and fess up. Funny how two years of thought process, and you end up somewhere you really shouldn't be.

I've spoken to my doctor about the new meds that have emerged over the last couple of years.

His point of view and the view in general of the Doctors at Penn is that treatments like Atripla and Reyataz + Truvada/Norvir or Epzicom are so very well studied and tolerable.

As some have shared. First Treatment Line can last for years, and Durability of these well studied drugs is well determined.

Overall, the Docs are telling me that they always want to know more about the newer meds. So right now, the disposition is, these current front line meds are really good and well studied. Go with them while information is still being collected and analyzed so that if your first treatment fails in hopefully a good number of years, these latest drugs will achieve the same or potentially better status. So for the 2nd line of treatment, best options can be played at that point. At least that's their thought process at this time.

I pushed the envelope... I took my supplements, (A multi Vitamin and Alpha Lipoic Acid, NAC and Acetyl-l-carntine combo, and 7 keto DHEA). I have scaled back my supplements to stick primarily to a multi vit and antioxident combination), with my meds and I cut my glutamine to 5 grams.

Today i feel a little bit quezy. Not too bad, but a bit off. I felt pretty good an hour after the meds, but in the afternoon... So I took a freezed dried Ginger Cap... Tomorrow I'll go back to Glutamine to 10 grams. And taking my supplements in the late afternoon and before bed.

I had a series of slight red blotches on my chest, which i periodically get since I've been HIV Positive. Possibly a case of sub dermatitis, I treated with some Hydro Cortisone cream. And in a few hours the blotches started to clear. i have no idea if it may be related to the meds or its just a part of an occasional flare up that i get from time to time. It also really bad allergy time in the northeast. So my eyes are watering severely, with the expected sneezing and some itching. So I'm not ready to say, med induced Rash.

I promised to start exercising, but today seems like a day to lay around. I'm going out to mow the yard, so I'll get out and about a bit.

I would say I'm feeling a bit tired today, but my canker sores that have been bothering me in the last month seem to be improving.

This upcoming weekend is going to be a big test for me. I'll be working a festival.

Because I felt queasy after dose 4, I returned to 10 grams of glutamine with Fiber after taking my pills. It has been noted that perhaps fiber with reyataz is a problem. I've looked into this, and I see nothing that indicates an issue with Psyillium and reyataz taken at the same time.I did not take my supplements. Intention is to wait until the afternoon and 2nd round before bed.

I did not have an issue today, so no need for ginger cap or imodium, which I took to work just in case.

Nothing to report except moments of feeling good! and Moments of fatigue or being tired. I took a nap when i got home.

I called the doctors office today to ask him about my formulation of using unboosted Reyataz and Truvada which is not recommended in the official guidelines. The doc was out so they had a nurse call me. I explained the situation, and initially, she said it seemed ok as unboosted reyataz is approved.... I had to point out that there is an issue with drug interaction which is why boosting is recommended with Truvada and other drugs that uses tenofovir. That If I was on Epzicom, unboosted is on the list....

I think she did a quick check and then.... "I'll call you back..."

Later in the day, instead of the nurse, my doctor called me.

He was apologetic. He more or less admitted he missed it, and he certainly should know better. I also shared with him that it starts as well with me, my last minute testing, somehow the appointment not being confirmed, and so we were both rushing when we should have been and I SHOULD have been preparing, reviewing, double checking. I pushed for Truvada and Unboosted Reyataz, and he let me.

Now he was able to look at things at a bit deeper level. The interaction concern is viewed as as a 25% decrease, Which confused me immediately. Well, I'm taking 400, so 25% is 300. So that not too bad is it? Apparently, its not what he meant.

If I understand what he was trying to tell me, is that the 25% is more of a performance degradation over time. Regardless, certainly if one is to combine a pill containing tenofovir and reyataz, one really needs to boost with norvir. And it is considered a small dose compared to how they used to use it.

He said he was fine with me taking the rest of the week to decide. To stay with the program. And choose between setting up a boosted reyataz regimen or switching to Epzicom.

He generally agreed with me that Epzicom is a good drug, but right now, durability of tenofovir in Truvada is first class. It seems that Truvada has the momentem and coupled with Reyataz which might be considered the current first class PI, it seems to make for an excellent, durable, tolerable combo. I just have to give in and boost with Norvir and deal with those Norvir issues. But, I am inclined to agree at this time that I'll go with boosting the Reyataz.

I did mention how someone else was in the same situation, and simply a prescription was provided to add Norvir to the 400 mg daily dose. My doc said he wanted to stay with the guideline of 300 reyataz and the 100 novir. And that they would help straighten it out with my prescription plan.

He also point blank stated that he should not have made this mistake. And that he is going to report it internally to the hospital pharmacy practice. I might get a call from the head of the department. Not only did he make this mistake, the nurse practitioner was also going to make the same mistake.

Truly I appreciate my doctors honesty. I let him know that keeping track of the long lists of protential interactions with all these HIV drugs is quite complex in my view. I drew an analogy from my business. It used to be I would have to sell maybe four products, and they were pretty clear cut. Now, I'm expected to sell literally a dozen related products and be able to mix and match them into working solution. Because of what I'm being asked to do, I depend on my other support organization to provide me with the information I need to do my job flawlessly. However, because everything is diluted into a dozen products, I don't get the support I used to when i only had 4. It is really the same thing, just two different fields.

The point is, I'm not as good as I used to be, but I'm still really good at what i do. Its just expected that I'm going to make mistakes from time to time. Of course making business mistakes, isn't quite the same as making mistakes with med combos, subtle as they might be. But none the less, should I blame the Person, or the system for the problem....

More importantly, what should I being doing as the customer? Am I an innocent? Certainly i should be carrying my own water, where possible. The choices we are asked to make are considerable. Doctors will ask us, what do you want to do? What do you think? What is important to you and what type of life do you want to lead?

If I left it to my doc, I'm sure he would have just put me on Atripla. But I had to be different, and explained how I would prefer a morning dosing scheme and wanting to go PI first.

I feel that we both dropped the ball. He certainly feels so as well. A humbling experience for both of us. But caught because of good advice from this board. Thank you guys! Really! I probably would have gone for quite some time with this regimine, and unfortunately, probably would have sacrificed durability of the treatment if is weren't for this board.

There are not that many 'issues' with Norvir. I know when I started I kept looking for things that weren't there. I could have sworn I saw them but looking back now I realize I made them all up.

What's important with having a good Dr is being a good patient. Sounds like you two are made for each other. I feel the same way about my Dr. When we started out together I was living in the Bay Area. (SF) We moved 5 hours N. and I supposed I could have looked for another Dr up here but for me it's no biggie (at least for now) to drive down and visit her for my check-ups every 4 months. It's a great excuse to cruise the streets of San Francisco.

Had to drop the car off for an early appointment, so i didn't have time for coffee.

Had the muffin and took my pills with the yogurt drink. I also did the Fiber and Glutamine drink. (10 grams of glutamine and fiber dissolved in about 10 oz of water.)

What was interesting was there was not a single rumble in my gut.... very easy morning.

At the dealer, had a small cup of coffee after about 1 1/2 hours after the pills. pretty good. Went home and had my normal cup of coffee... then the rumbling began... and I started to feel pretty crappy after a couple of hours... still not feeling all that...

Coffee.... I like to have a couple of cups a day... I may have to give it up....

Otherwise, skin is clear and in fact looking a bit better overall. No other complaints.

Since I think coffee might be a bit of a problem, at least for now, i switched to a cup of tea with breakfast, yogurt, meds, glutamine and fiber drink.

Generally, I felt ok, but I'm still getting plenty tired in the mid to late afternoon. Which lasts until the early evening. I thought that the tea was a better choice than the coffee, but maybe I just need to get off of caffeine.

So far, digestive effects are minimal. No Skin Rash's or discoloration. The only thing of note is the mid to late afternoon crash. Canker sores have cleared up.

After 1 week, overall, the sides were for me, minimal. I did take preventive steps digestively with the yogurt, fiber, glutamine and occassional ginger cap. I had no need for imodium. I did experience gassy moments, but nothing to unpleasant. And today without the coffee, i had less.

But really, there has been only minor issues and the only complaint I have is the afternoon crash.

I'm going away for the weekend, and this is going to be interesting. I'm working a music festival. I will take my meds and right now I'm planning on how I'm going to do this. I'll be reporting back Sunday or Monday, and share how I felt being more physically challenged.

if you were to ask me if its worth it right now, I'd say, of course. It hasn't been a problem really. No yuck or icky moments. No diarrhea. No nausea I couldn't manage with ginger. No discoloration of the eyes, or skin. No Rash. No headache to speak of. The only thing is that afternoon crash. And that's just being sleepy.

Next Tuesday I talk to my doctor about adding norvir to correct the problem with my unboosted reyataz with truvada problem. Because I'm pretty comfortable at the moment with the reyataz and truvada, I think that's what I'll stay with instead of switching truvada out for epzicom.

Actually at Dose 8, things are in general better. While I would say that the side effects were very mild and I would say acceptable, I'm having fewer noticeable effects at all.

I had a hard working weekend at a festival. Long days, Late Nights, heavy lifting, pressure, stress....

I also had a blast.

And not once did i think. I feel off or limited or worried.

And the benefits are starting to show. Instead of being totally out of it today, I'm doing really well. My last festival, with my CD4 crashing, it took me four days to recover.

Today's dose.... i don't think I have a single issue to discuss.

Tuesday i call my Doctor to tell him to work out how to incorporate Norvir into my routine. Thumbs up to Truvada and Reyataz for me.

I'm going to continue this log when Norvir is added to report on that for one week.

And if all goes well, I'll update at my blood tests and share results and update on sides. I realize that tolerable today, doesn't mean clear sailing forever. That there are things to watch for and preventative steps I should be working on to improve durability, my health overall, and my vascular, digestive, renal and hepatic systems.

Norvir Update. Well to correct my combo, I've decided to add Norvir. The Truvada and Reyataz combo looks to good to me.

I worked with the nurse practitioner and she found a 100 mg tablet of Reyataz. So instead of a 300 meg capsule, and loosing 3 months of supply of 2x200mg reyataz, I'm going to take one 200 + one 100 reyataz, 1 truvada tablet, and one 100 mg Norvir.

She was surprised to see reyataz in such low doses and openly wondered why they exist.

But it solves a problem and prevents waste and the pharmacy went along with it. As usual, they don't have a full 90 day supply. So I'm going to pick it up tomorrow and start boosting thur. I'll document any sides I experience.

Glad to see you taking the step to add Norvir. I was on the same (reyataz, truvada and norivir) but for some weird reason i would always feel exhausted and wiped out. So my doc said lets take Norvir out and see what happens. A month before taking out norvir i was undect. and about 800 with cd4. The i started the new dose and 2 weeks later i was still undect. and cd4 of 450..according to the doc and pharmasist, they both showed me a chart showing that my system still absorbs the same way it should with Norvir. Now with all this said, i feel better but am worried am i doing the right thing? I was told over and over again that this is an alternative method and it works for alot of people. But keep me posted with the Norvir ..i think after this month i may consider to go back on it because the stress of not taking it is just getting to me!

My doc questioned why the pharmacist didn't object to the formulation. According to the guidelines and how tenofovir interacts with Reyataz, as told to me by my doctor after the board identified a "problem" with my combo, there is a 25% degradation of performance of Reyataz.

If you don't boost Reyataz, the dose needs to be 400mg. (recommended). Initially, I was thinking this meant we would be under performing at 25%... But I'm still not sure I understand what this 25% performance degradation really means.

Regardless, it is documented that the tenofovir component reduces Reyataz in the blood, and Novir couteracts this.

Should you be stressing out? I just started, so I'm looking at my non recommended combo as a ramp to the full formula. I started norvir yesterday, and got a 100mg reyataz, so I combine my stock of 200 with the 100 to get to the recommended 300 mg dose.

I asked about what the norvir does in the combo. 100mg is considered a small dose just to inhibit the liver from breaking down the reyataz so quickly. Norvir is a PI, but its only real use anymore is to inhibit certain PI"s from being impacted by drugs like tenofovir.

He was always pushing me this way, to use the norvir... The idea is more is better, or keeping the concentration up in the blood over the 24 hour period. I really think doctors are focusing on trying to keep the "WALL" up with the first line combo for as long as possible. The focus clearly is on preventing HIV mutation.

While in my mind, Reyataz seems to be a better choice than Kaletra, which is the subject of many studies, there is always some doubt because I still think doctors see Kaletra as the Gold Standard of PI. Reyataz is like the new kid on the block. More information exists on Kaletra, because its been around longer. And there are even thoughts about mono therapy with Kaletra, which my doc would never go for.

But it seems like in study after study, Reyataz is fairing well, and the tolerability/performance and durability are on par.

But each of us are individuals, and that's what's tricky about this business. So far I'm feeling really good with the Combo. But now I have to adjust to the Norvir. So we shall see. Would Norvir be that difference? Can't we just take more Reyataz? Say 500 mg? At some point if we go off script, doctors won't have that baseline of information of which to draw from.

I would say that doctors, in general, don't want to veer from the study based standards. That creativity, is hard to come by and may in fact be harmful to us, cos if we don't get it right, then we can get mutations, or we can have too much medicine. Such a fine line to walk.

So, of course I can see why you'd stress out. If its working, we don't want to mess it up.

at day 14,,, I'm feeling lots better in general. I'm getting back into the old habit of staying up way to late. Cos I have my energy back. I'm not sleeping enough, but I'm feeling so much better, I'm not falling asleep... Although today, I don't think I'll make it without a nap.

One thing I've noticed, which surprises me. Instead of the expected Diarrhea, I'm actually a little be constipated. The fiber is keeping things moving though. So I'm very very surprised.

One thing for sure, we are all different. The statistics are generalities or set expectations. But you don't know til you get there. For me, its a life changer, and will be a life extender. (Well I hope it is). It wasn't going that well without anyways.

I do know its time to exercise. I have a sneaking suspicion that helps manage toxicity over the longer term. Something I have to invest effort and time in.

Still taking Supps, but sticking to the Anti's and Multi and glutamine... I do take 7 keto dhea, and have done so for years. Morphing the supps role to deal with possible tox issues. (Metobolic, Inflamatory, etc.)

I did stop the Herbals supps... but not the "HERBAL" supp... nudge nudge and wink!

I've just started on the same 3 combo you are on. I'm on day 2, I haven't really noticed anything different, then what I have already been feeling. It maybe just that I am so tired from not sleeping, that I just don't notice any either side effect. All the medications and different combos are so overwhelming, I was only diagnosed 5 weeks ago. I know there are things I should be doing, but I just don't have the energy or drive. In order to keep my anxiety level down I've been using an herbal supplement . Its good to hear that the combo seems to be working for you. The ID doc told me it would take a couple of weeks for me to notice any difference.

My Doctor recomended this combo when she noticed my worries from body shape changes, she said they are less with this combo !!!how accurate that is ? initiaaly she wanted me to be on Atripla but now she thinks this is better for me since my main concerns were body wasting and mental problems

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I have to admit : the good thing is that from now on; I have no option but to succeed , still its ok to worry

They will spend a good bit of time talking about all the things that just might go wrong, especially if they are very experienced ID docs. My doc has been in this field for 22 years, and in a university practice. he's seen it all....

They say, Lipo issues were associated with a class of drug that Zerit fit in. Now Zerit worked, does work, saved lives. But it did have lipo problems. All the early drugs have issues associated with them.

And that continued onto Kaletra, another life saving powerful, potent durable drug. But also more serious side effects.

Reyataz is different. And its popularity is associated with its Tolerability, Durability of Kaletra without many of the digestive and importantly fat changing effects as measured by triglycerides. Because Reyataz does as readily affect triglycerides, it is thought not to have LIPO issues associated with it. And it isn't of the Zerit Class, which my doctor will say, there are a few drugs where it is clearly a problem with it.

Apparently, Atripla, and Reyataz based front line combos, aren't as susceptible to these issues. But they won't say, it doesn't happen. Cos, the drug has only been around for 5/6 years. Long term is the issue. So they don't know. But I'm not aware of any associations with Reyataz and lipo issues.

So should you believe your doctor. Well, she's saying the same thing as my doctor. And if you look at treatment news, you can see for yourself. They put in as possible side effects now, many of the things that effect the whole class of ARV drugs. So, just because its a list as a possible, doesn't mean it likely. Some drugs are better and some are worse and what complicates it, how our bodies respond is individual. The general statistical population will do well. But there always are the exception.

Are you an exception? Seem like that's what we worry about in general. I'm the unlucky one. Maybe your luck will be ok on this issue.

I just know I'm craving sweets, so I'm going to have a different fat issue, like all over!

Thank you for the great clarification, so if I understood correctly, this combo is not as aggressive when it comes to body shape changes, still the long term effect is not known since its new?

So the question is when it comes to compare it to Atripla, how can the doctor say that its less associated with body fat change when Atripla is even newer than this combo.Hope i am not asking a lot, just trying to make the right decisionBest wishes

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I have to admit : the good thing is that from now on; I have no option but to succeed , still its ok to worry

I'm definitely not qualified to work with you to determine what the "safest" course is if LIPO problems are your main concern.

But my doc talk about...

Stavudine is an analog of thymidine. Thymidine based drugs are implicated with LIPO. On this board alone you hear about particularly about Zerit.

But other drugs have lipid effects, which are implicated in Lipo issues.

And I don't know if the record is perfect for the current batch. But as a PI, reyataz has apparently less lipid effects that other PI's. The idea is less Lipid effect, less LIPO results.

I don't know the profile of Atripla as well as Reyataz, but a little research can help you through this.

This is my opinion on Atripla, and this is why I choose PI.

For me, taking 3 or 4 pills every morning is not a burden. I will adhere. In fact its seems strange to me to take pills once a day for something. My supp routine was at least twice a day, and If i could squeeze it in, some were 3 times a day.

Doctors worry more about adherence than anything. We have to take our meds every day. We might miss a dose now and then, and that isn't going to blow treatment, but simply, its best to take every day.

Atripla is one pill once a day. Its easy, and it has I believe it has 80% of the market. Or some ridiculous high number.

Most people seem to take it a night, to clear groggy effects that one might if taken in the day. I simply cannot maintain a regular enough schedule to deal with night time dosing.

And, there are some noted issues with Atripla, but there are issues with all ARV's. For me, a PI based routine in the morning made the most sense from a dosing standpoint, and I wanted to start PI particularly Reyataz and matched it to Truvada with a Norvir dose for boosting Reyataz.

From my vantage point, my doc made no pointed reference to LIPO issues with either of these drugs. His point is that LIPO issues were largely associated with thymidine analogs, and neither is in this class.

But talk with your doctor and ask if they see issues in their patients on Atripla and Reyataz

They have been around a while though, so we should start seeing better information about potential LIPO effects. But it apparently happened pretty quickly with zerit.

Just reading over your thread, since you were kind enough to participate in mine... I'm glad you're doing so well!

I noticed you said you developed a sweet tooth too... I had the same thing. I wonder if this is our brain's "reward center" demanding attention, or if it's some function of the metabolism of the medicine? I know that I hadn't desired anything sweet in a long, long time... and suddenly found myself buying a chocolate cake at 2 in the morning because I "needed" some chocolate so much!

I've always had a sweet tooth, but it was like, I'll get some chocolate, and I would be good. And I do like dessert.

It just seems, more driven... I had a twix bar today... I never eat a twix bar...

Almond Joy's are a new rave.

Popsicles! Orange Creamsicles! (that is really really good!)

I don't know what's behind it... but I do know I was thought to be "pre or simply" diabetic, because of symptoms. But the AIC didn't show a problem, but then the AIC isn't reliable in certain...whatever.

I have a friend where they think the same thing. I would be surprised at all that HIV metobolic impact may very well create a Pre Diabetic condition. After meds. Something clicks and now I'm craving sweets.

I of course have no evidence of this... or real first hand knowledge. It just as easily be the meds.

My digestive track is so much better too. Really Really normal. I haven't been this normal since I was NEG for that matter. If the digestive track improves dramatically, and HIV primarliy, my understanding, is in the digestive area, perhaps that's related.

Today was not as good as the others. I got a caffeine like withdrawl headache in the afternoon. Funny because after I go through Withdrawl, which I did the day before, usually I'm good. Since it seemed like one, I got some pepsi and it really helped.

Also feeling a bit funny today. Its been about 5 doses of Norvir so far, and I'm thinking that there is a difference. Obviously it changes the level of reyataz in my blood, and is a new component in the meds. So today, I felt more like I did initially, say two or three.

Good moments, and tired moments, and that headache...

Gona get some sleep tonight. I don't think I've been sleeping enough.

On a scale of 1 - 10,,, 7... better than just before meds. My mood and just general well being was evident. But i'm giving some back because the afternoon was a bit rough. Really tired now 9pm.

Dose 19, everything great in the morning, had too heavy of a lunch, and started to feel a pressure in my head, not a headache like yesterday. didn't really bother me. I felt stuff like that before and its ok.

After adding norvir, adjustment is taking a bit longer than I expected. I know the norvir is boosting reyataz. Is it the reyataz or the norvir...

Anyways, I'm just going to bed early tonight and get some much needed rest.

FYI - I've been working the whole time, and doing my side projects. Keeping busy, combo has not prevented me from doing anything I want to. Although yesterday's headache would have been a problem.

Saturday sucked... but not because of the combo. if my back get chilled at night, I often have a tension headache the following day. Had to fight it all day. My rash or the red bloches on my skin, disappeared by sat.

Sunday.... no issues to report. I felt fine today.. Starting a lifting program and did a bit on sat... A good sore feeling.

I'll summarize the log from here on out every few days and I believe I've passed through the initial adjustment period, I'll be going in to see the doc. in a week and get my 1st blood test.

Very helpful blog risred. I recently started on this combo, for a few weeks now, and have also experienced constipation rather than diareah. Not sure if its related to the fact that I have a cough/cold but I suspect its the medication. Any ideas?

It one that is orange flavored and you mix a heaping teaspoon with water.

And I take my pills with a yogurt smoothie.

Actually, the constipation was a surprise, but I think it was because I was taking 10 grams of glutamine. Once i cut that back to my regualr 5 grams daily dose, things pretty much got back to normal.

But it just may be the adjustment period. Normally we associate diarrhea with PI based meds, but Reyataz just doesn't seem to trigger the same types of side effects, although its listed.

So our focus is on diarrhea, but now we know that it can go the other way.

Also drink more fluids too. I craved sweets and drinks and water first few weeks. But that's has subsided. Maybe its just all about the transitionary period, I'm completing my 4th week on Thurs, and I'm seeing my doctor and getting blood tests. But over all, this last week, I haven't been thinking much about the pills at all. Although I still get tired spells, but my body isn't going to flip totally around in just a few weeks, although I feel alot better overall.

Give the fiber supplement a try, I'm going to keep it in my program, it really makes everything work the way its supposed to!

That was very helpful, it's good to know that I'm not the only one that is bloated. Never been this bloated for so long in my life! I hope it subsides as it did with you, and I will go out and buy some fiber supplements.

I take my pills at night, I notice I get immediate heartburn from it. I wonder if I should switch to mornings though.

That was very helpful, it's good to know that I'm not the only one that is bloated. Never been this bloated for so long in my life! I hope it subsides as it did with you, and I will go out and buy some fiber supplements.

I take my pills at night, I notice I get immediate heartburn from it. I wonder if I should switch to mornings though.

Remember there are interactions with certain heartburn medications and some HIV meds such as Reyataz.

I take my pills at night, I notice I get immediate heartburn from it. I wonder if I should switch to mornings though.

I notice a "warm" feeling that's a step-and-a-half away from being heartburn around thirty minutes after taking Reyataz. I take mine with breakfast because I find it's the easiest meal to take at a set time each day. I'd imagine lying down after taking my meds would make the "warm" feeling quite uncomfortable.